A team of UCLA researchers has received a $4.6 million grant from the National Institutes of Health to study ways to get HIV-positive men who have been released from Los Angeles County jails into medical care and on sustained treatment.

The study -- one of 12 taking place across the nation as part of the NIH's "Seek, Test and Treat: Addressing HIV in the Criminal Justice System" initiative -- will be a randomized controlled trial of an intervention that seeks to improve the men's health and prevent transmission of HIV to others in their communities.

The project could have a long-term impact on the HIV epidemic in Los Angeles because it focuses on short-term jail inmates, who are currently understudied in relation to long-term prison inmates, said to Dr. William Cunningham, the study's co-principal investigator and a professor of medicine in the division of general internal medicine and health services research at the David Geffen School of Medicine at UCLA. The project would be the first to both implement and rigorously evaluate a promising and innovative intervention, he said.

"Many more people go through jails than prisons, and the Los Angeles County jail system is the largest in the U.S. and maybe the world," said Cunningham, who is also a professor of public health at the UCLA School of Public Health. "We have to focus on jails' role in the HIV epidemic because recidivism rates for HIV-positive men are extremely high -- it's like a 'revolving door' between the community and the jail."

The innovative project -- known as a peer-navigation intervention -- uses trained staff with backgrounds similar to the study participants to help guide the HIV-positive men through the complex health care system. Researchers will measure the men's health changes over time, including those related to prevention, and will examine how the strategy works for substance users and determine whether the intervention is cost-effective and prevents unnecessary hospital and emergency room use. They will also analyze re-arrest or jail recidivism.
Each year, an estimated one in seven individuals infected with HIV passes through a correctional facility, suggesting that a disproportionate number of people in the criminal justice system are infected with the virus.

HIV-positive individuals who cycle through the Los Angeles County jail system are more likely to be out of medical care and off treatment and to have high HIV viral loads, said co-principal investigator Dr. Jennifer Sayles, medical director of the Los Angeles County Department of Public Health's Office of AIDS Programs and Policy.

"This, in turn, contributes to significant health disparities among incarcerated individuals living with HIV/AIDS, as well as increased transmission risk due to low rates of antiretroviral therapy use, which further fuels the HIV epidemic locally," she said. "If effective, the proposed intervention could play a key role in the public health response to HIV/AIDS in Los Angeles and serve as a model for jurisdictions across the county."

Other UCLA researchers on the five-year study are Susan Ettner, a professor in the division of general internal medicine and health services research and a professor of public health, and Steven Shoptaw, a professor of family medicine and of psychiatry and biobehavioral sciences. Other researchers include Dr. Mark Malek of the Los Angeles County Sheriff's Department and Trista Bingham of the Los Angeles County Department of Health Services.

"Seek, Test and Treat" represents the NIH's largest research initiative to date to aggressively identify and treat HIV-positive inmates, parolees and probationers and to help them continue care when they return to their communities. The grants come primarily from the National Institute on Drug Abuse (NIDA), with additional support from the National Institute of Mental Health (NIMH) and the National Institute of Allergy and Infectious Diseases (NIAID), all components of NIH.

Other projects will focus on the Cook County Jail in Chicago, Rikers Island correctional facility in New York, jail facilities in Washington, D.C., and prison systems in Illinois, North Carolina, Texas, Wisconsin and Rhode Island.

One of the grants will compare levels of care and adherence to highly active antiretroviral therapy treatment (HAART) among injection-drug using, HIV-positive detainees in Hanoi, Vietnam, a city with a high rate of HIV infection related to drug use. Two of the projects will study the effectiveness of medication used to treat heroin addiction among HIV-positive injection-drug users who are transitioning to home communities.

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The General Internal Medicine and Health Services Research Division in the department of medicine at the David Geffen School of Medicine at UCLA provides a unique interactive environment for collaborative efforts between health services researchers and clinical experts with experience in evidence-based work. The division's 100-plus clinicians and researchers are engaged in a wide variety of projects that examine issues related to access to care, quality of care, health measurement, physician education, clinical ethics and doctor-patient
communication. Researchers in the division have close working relationships with economists, statisticians, social scientists and other specialists throughout UCLA and frequently collaborate with their counterparts at the RAND Corp. and the Charles Drew University of Medicine and Science.

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